OSTEONECROSIS IN THE JAWBONE INDUCED BY BISPHOSPHONATES: REVIEW OF THE LITERATURE AND CASE REPORT

Abstract

Bisphosphonates are drugs commonly used in the osteoporosis treatment and in neoplasms with metastasis in the osseous tissue. Recently a strong relationship between the chronic use of these medicines and the development of an osteonecrosis in the jawbone, clinically characterized by the osseous exposure in these places has been identified. Such lesions may show its origin in dental intervention, like dental extractions, emphasizing the importance of the complete elimination of infectious processes before the bisphosphonates treatment. In this study, the authors review the literature about the osteonecrosis induced by bisphosphonates, describe a clinical case of a patient affected by the referred complication, and they also search for treatment orientations, prevention and recommendations based on the current knowledge of this pathology. A synergy between the health professionals – oncologists and dentists – must exist with the intention to inform the patient about the risk-benefit of the bisphosphonates treatment. Previous consultations with dentists who prioritize the elimination of any possible focus of oral infection, decrease of biofilm accumulation, elimination of caries and deficient restorations, perfect adjustment of prosthese and orientation for an appropriate oral hygiene are the most effective preventive measures. Exodontia or any other traumatic procedures must be avoided mainly during the treatment with bisphosphonates. Interrupting the therapy must be thoroughly discussed by the professionals involved, seeking to list its advantages and disadvantages. Antibiotic therapy seems to be the most effective way to control the necrotic lesions.